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J Am Med Dir Assoc. 2019 May 2. pii: S1525-8610(19)30305-6. doi: 10.1016/j.jamda.2019.03.018. [Epub ahead of print]

Preparing Long-Term Care Staff to Meet the Needs of Aging Persons With Serious Mental Illness.

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VA Capitol Healthcare Network, Mental Illness Research Education and Clinical Center, Baltimore, MD; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD. Electronic address:
Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI; Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI.
Charlie Norwood VA Medical Center, Augusta, GA; Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA.
VA Pacific Islands Healthcare System, Honolulu, HI.
School of Aging Studies, University of South Florida, Tampa, FL.



Individuals with serious mental illness (SMI; schizophrenia spectrum disorders and affective psychoses) are increasingly aging into older adulthood and are overrepresented in residential long-term care settings. The present study aimed to examine the preparedness of staff in these settings to care for individuals with SMI.


A multidisciplinary US Department of Veterans Affairs (VA) workgroup of professionals with expertise in geriatric mental health collected voluntary feedback via online questionnaire as part of a quality improvement project.


Respondents were mental health providers (N=51) embedded in VA nursing homes called Community Living Centers (CLCs).


The questionnaire contained multiple-choice, Likert-type scale, and open-ended questions regarding the opportunities and challenges associated with caring for Veterans with SMI in CLCs.


Respondents identified a lack of training of front-line staff as a key challenge in providing high-quality care to residents with SMI. Specifically, respondents indicated a need to increase staff knowledge about SMI symptoms and diagnoses, to improve staff communication and interactions with residents with SMI, and to decrease mental illness stigma among staff.


The present study revealed significant areas of training need for front-line staff in nursing homes. Many perceived staff training needs overlap with the knowledge and skill set required to provide high-quality dementia care. Integrating training regarding the care of residents with SMI into dementia care training efforts may be a fruitful future direction. Strategies for this and a suggested curriculum are provided.


Serious mental illness; assisted living; long-term care; nursing homes; staff training

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